Agreement of glaucoma specialists and experienced optometrists in gonioscopy and optic disc evaluation

Kumar, Addepalli U.; Jonnadula, Ganesh Babu; Garudadri, Chandra S.; Rao, Harsha L.; Senthil, Sirisha; Papas, Eric; Sankaridurg, Padmaja; Khanna, Rohit C

doi:10.1016/j.optom.2013.09.002

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…Other angle imaging methods, such as AS-OCT or UBM, can provide accurate morphologic and morphometric data on angle structures, which may be important, for example, to correctly diagnose a plateau iris,17,18 an ICA feature our study showed to have a poor agreement (although not statistically significant) using automated gonioscopy. However, automated gonioscopy pictures hold the advantage of being a representation of what the ophthalmologist actually sees during gonioscopy, and as our study shows, it can identify and grade changes such as PAS, angle vessels, trabecular pigmentation, and surgical iatrogenesis, which neither AS-OCT nor UBM would be able to document.…”

Section: Discussionmentioning

confidence: 59%

Agreement Analysis on Angle Characteristics With Automated Gonioscopy

Barão

Cutolo

Tanito

et al. 2021

Journal of Glaucoma

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Précis: Automated gonioscopy is a recent method of recording angle pictures. Our study shows that agreement between observers is moderate in most categories used in clinical practice, underlying its clinical usefulness but also room for improvement.Introduction: Iridocorneal angle (ICA) imaging methods have been recently developed to record gonioscopic images. The purpose of this study was to perform an interrater agreement analysis of ICA photographs.Methods: Multicentric cross-sectional observational study. Consecutive patients in 2 ophthalmology departments underwent automated gonioscopy. One picture per quadrant from each eye was selected for randomization. Pictures were graded and analyzed by 4 masked glaucoma specialists regarding angle opening, width, Shaffer and Spaeth gradings and other findings. Fleiss' κ statistics was performed to assess interrater agreement.Results: A total of 50 patients were recruited, with the sample containing a variety of diagnosis including pseudoexfoliation (22%), angle-closure suspect (12%), and pigmentary glaucoma (4%). The sample included phakic (68%) and pseudophakic patients, as well as cases with gonio-implanted surgical devices (10%). There was moderate agreement on angle opening, angle width, presence of angle vessels, and peripheral anterior synechiae (κ = 0.435, 0.511, 0.558, 0.488, respectively; P < 0.01). Fair agreement was observed regarding Shaffer grading, site of iris root insertion, angle pigmentation features, and the presence of iris processes. Expectedly from a 2-dimensional picture, the configuration of peripheral iris was found to have a poor agreement. Subset analysis on higher quality pictures seemed to improve agreement on pigment but did not further improve on the overall good agreement on angle opening status.Conclusions: Our study shows that automated gonioscopy provides moderate agreement on most clinically relevant features. Binary characteristics such as angle opening or PAS seem to be more robust than more complex angle classification parameters.

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Section: Discussionmentioning

confidence: 59%

Agreement Analysis on Angle Characteristics With Automated Gonioscopy

Barão

Cutolo

Tanito

et al. 2021

Journal of Glaucoma

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“…Hence, it is evident that with sufficient training and experience, optometrists would be efficient in evaluating patients with glaucoma. [ 14 15 16 ] The ophthalmic community has to be sensitized regarding the need to perform gonioscopy to minimize the problem of misdiagnosis or under diagnoses of angle closure. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Assessment of knowledge, attitude, and practice of glaucoma among different cadres of optometrists

Asokan

Saravanan

Negiloni

2022

Indian Journal of Ophthalmology

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Purpose: To assess the level of knowledge, attitude, and clinical practice of glaucoma among optometry students and optometry practitioners with different years of clinical experience and academic background. Methods: A survey with 20 questions on knowledge, attitude, and practice (KAP) of glaucoma was prepared and self-administered to optometry students and optometry practitioners practicing in an eye hospital/clinic/optical with varied years of clinical experience and education qualification. Results: Among the 558 participants, 57% were optometry practitioners and 43% were students. The knowledge scores among optometry practitioners increased significantly with an increase in the years of clinical experience ( P < 0.001). Participants with master’s degrees scored higher than participants with bachelor’s degrees ( P = 0.12). There was no statistically significant difference in knowledge scores based on the type of clinical practice - hospital, private practice, or optical ( P = 0.39). Practicing optometrists who performed slit-lamp examination, gonioscopy, IOP measurements, and disc evaluation for the detection of glaucoma had significantly higher knowledge scores than those who did not perform these tests in their practice ( P < 0.05). A positive attitude toward glaucoma learning through workshops and hands-on training was reported by optometrists and students. Conclusion: Knowledge about glaucoma was good among optometrists and optometry students and was better among those who handled the diagnostics. All the optometrists had a positive attitude toward enhancing their practice through proper training.

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“…Recently published data indicated that surveyed optometrists were not confident performing gonioscopy and pachymetry, which impacted on the otherwise high level of compliance with a satisfactory glaucoma examination. Gonioscopy should be an integral part of vigilant glaucoma evaluations, and optometrists are capable of applying gonioscopy with a sensitivity and specificity similar to glaucoma specialists . It should be noted that van Herick's angle depth estimation as well as a number of automated methods are not suitable substitutes for gonioscopy .…”

Section: Discussionmentioning

confidence: 99%

Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists

Zangerl¹,

Hayen

Mitchell

et al. 2015

Ophthalmic Physiologic Optic

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Optometrists in Australia and New Zealand may not always exercise optimal clinical acumen regarding techniques/criteria for glaucoma diagnosis. Therapeutic endorsement was gradually adopted in different jurisdictions in various forms since 1999 and is mandatory for registration since late 2014. The result of the two-tiered optometric cohorts suggest that inclusion of therapeutic training as part of the core training is likely a key factor to enhanced compliance with glaucoma guidelines. Improved adherence to the current clinical standards should positively impact on the facilitation of appropriate glaucoma diagnosis and management. Obligatory knowledge and possibly accreditation of available guidelines might ensure a uniform standard in glaucoma testing protocols in concordance with compulsory entry-level skills.

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Agreement of glaucoma specialists and experienced optometrists in gonioscopy and optic disc evaluation

Cited by 9 publications

References 22 publications

Agreement Analysis on Angle Characteristics With Automated Gonioscopy

Agreement Analysis on Angle Characteristics With Automated Gonioscopy

Assessment of knowledge, attitude, and practice of glaucoma among different cadres of optometrists

Therapeutic endorsement enhances compliance with national glaucoma guidelines in Australian and New Zealand optometrists

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